Significant Difference In Wound Infection Research Articles

Wound Irrigation Using Normal Saline 0.9% Versus Tap Water: A Review for Street Medicine and Low-resource Providers

Patients experiencing homelessness are a vulnerable cohort who suffer from disproportionate skin disease burden. Acute and chronic wounds represent high morbidity conditions with severe consequences. Adequate management in the form of cleansing and irrigation is necessary for removing cellular debris, bacteria and contaminants. Providers in low-resource street medicine settings may be the first point of contact in the management of wounds encountered by unhoused patients. This review determines the feasibility of improvised irrigation techniques that can be used in street settings to irrigate wounds. A MEDLINE search was conducted and yielded randomized controlled trials, laboratory studies and case-control studies. No significant difference in wound infection and healing rates was found when normal saline 0.9% or tap water was used in wound irrigation. Improvised cleansing devices with suitable irrigation pressure included water bottles punctured with 14-18-gauge needles, 10-mL syringes and 50-syringes. Lower and upper extremity wounds were found to be at higher risk of infection, requiring judicious management and cleaning. Street medicine providers should consider weighing the benefits versus risks of on-site, improvised wound irrigation for acute soft tissue injuries, especially in the setting of limited resources.

Thoracoscopic versus thoracotomy lobectomy in children with congenital lung lesions: a systematic review and meta-analysis.

Thoracoscopic lobectomy is always compared with open thoracotomy in congenital lung lesions with no definitive results. This systematic review and meta-analysis compared the clinical outcomes of thoracoscopic versus thoracotomy lobectomy in children. The electronic databases MEDLINE, EMBASE, and PubMed were searched. A meta-analysis was used to analyse and compare the operating time, length of hospital stay, and postoperative complications, such as wound infections and respiratory issues, in thoracoscopic and thoracotomy lobectomy. Two thousand and ninety five paediatric patients were analysed over 17 studies (1 ambidirectional cohort study and 16 retrospective studies). Of these patients, 903 and 1192 had undergone thoracoscopic lobectomy and thoracotomy, respectively. There was a significant lower incidence of overall and respiratory complications and longer operative time for thoracoscopic lobectomy compared with thoracotomy in children; however, pooling the results for the two methods revealed no significant difference in wound infection or length of hospital stay. Thoracoscopic lobectomy offers the benefit of having fewer overall and respiratory complications than thoracotomy. It did not, however, clearly outperform open surgery in terms of operative time, wound infection, or postoperative hospitalization.

Effect of minimally invasive versus conventional aortic root replacement on transfusion and postoperative wound complications in patients: A meta-analysis.

We examined whether small incision aortic root replacement could reduce the amount of blood transfusion during operation and the risk of postoperative complications. An extensive e-review of the 4 main databases (PubMed, Cochrane, Web of Science and EMBASE) was carried out to determine all the published trials by July 2023. The search terms used were associated with partial versus full sternotomy and aortic root. This analysis only included the study articles that compared partial and full sternotomy. After excluding articles based on titles or abstracts, selected full-text articles had reference lists searched for any potential further articles. We analysed a total of 2167 subjects from 10 comparable trials. The minimally invasive aortic root graft in breastbone decreased the duration of hospitalization (MD, -2.58; 95% CI, -3.15, -2.01, p < 0.0001) and intraoperative red blood cell transfusion (MD, -1.27; 95% CI, -2.34, -0.19, p = 0.02). However, there were no significant differences in wound infection (OR, 0.88; 95% CI, 0.16, 4.93, p = 0.88), re-exploration for bleeding (OR, 0.96; 95% CI, 0.60, 1.53, p = 0.86), intraoperative blood loss (MD, -259.19; 95% CI, -615.11, 96.73, p = 0.15) and operative time (MD, -7.39; 95% CI, -19.10, 4.32, p = 0.22); the results showed that the microsternotomy did not differ significantly from that of the routine approach. Small sternotomy may be an effective and safe substitute for the treatment of the aorta root. Nevertheless, the wide variety of data indicates that larger, well-designed studies are required to back up the current limited literature evidence showing a benefit in terms of complications like postoperative wound infections or the volume of intraoperative red blood cell transfusion.

The Efficiency and Safety of Platelet-Rich Plasma Dressing in the Treatment of Chronic Wounds: A Systematic Review and Meta-Analysis of Randomized Controlled Trials

Recently, many clinical trials have applied platelet-rich plasma (PRP) dressings to treat wounds that have stopped healing, which are also called chronic wounds. However, the clinical efficiency of PRP dressings in treating chronic wounds is still controversial. Therefore, we conducted this study to compare PRP dressings with normal saline dressings in treating chronic wounds. Relevant randomized controlled trials focusing on utilizing PRP dressings in treating chronic wounds were extracted from bibliographic databases. Finally, 330 patients with chronic wounds, reported in eight randomized controlled trials, were included in this study. In total, 169 out of 330 (51.21%) were treated with PRP dressings, and 161 out of 330 (48.79%) were treated with normal saline dressings. The pooled results showed that the complete healing rate of the PRP group was significantly higher than that of saline group at 8 weeks and 12 weeks, respectively. In addition, there were no significant differences in wound infection and adverse events. Compared with normal saline dressing, the PRP dressing could effectively enhance the prognosis of chronic wounds. Furthermore, the PRP did not increase wound infection rate or occurrence of adverse events as an available treatment for chronic wounds.

Staples Versus Sutures for Skin Closure in Standard Four Port Laparoscopic Cholecystectomy: A Prospective Cohort Study.

IntroductionMany studies have been done comparing sutures versus skin staples in various wounds. To the author's knowledge, there is no study comparing these two in an laparoscopic cholecystectomy (LC) wound. Our study aims at comparing the clinical outcome of skin closure by monofilament nylon suture and stainless-steel skin stapler in standard four-port LC. The results of this study can help in developing guidelines for skin closure in LC.ObjectiveTo compare the clinical outcome of skin closure by monofilament nylon suture and stainless-steel skin stapler in standard four-port LC.MethodsThe study was conducted as a time-bound prospective cohort study on diagnosed patients of cholelithiasis admitted in a single unit of the Department of Surgery at All India Institute of Medical Sciences, Rishikesh, India from February 2018 to February 2019. The standard four-port LC was done by the same surgeon. After the completion of the surgery, port closure was done using absorbable sutures, and skin was closed by either 2.0 monofilament nylon suture (Ethilon, Ethicon, Scotland) or stainless-steel staples (Proximate plus MD, 35W, Ethicon, Scotland). The time taken for skin closure in both the groups was noted using a stopwatch. Each wound was assessed on the post of day (POD) 1 during discharge, on POD 10 during suture/stapler removal, and POD 30 by the operating surgeon for pain, wound infection, scar status using validated scales.Statistical analysis usedThe outcome measures were calculated as mean and standard deviation. Continuous variables were analyzed using a two-tailed student t-test.ResultsOut of 48 suture vs 45 stapler cases the average time for closure is 277.14 seconds in suture vs 77.2 seconds (p = 0.0001) in the stapler group. All other parameters studied were not statistically significant among the two cohorts.ConclusionWe conclude that stapler requires minimum time for closure with no statistically significant difference in wound infection, post-op pain, pain during removal, and scar results are the same in both the groups.

Comparison of surgical techniques for benign parotid tumours: a multicentre retrospective study

This study aimed to compare the outcomes of three surgical techniques for the treatment of patients with benign parotid tumours: superficial parotidectomy (SP; group 1), partial superficial parotidectomy (PSP; group 2), and ultrasonic scalpel-assisted minimal extracapsular dissection (US-MECD; group 3). Groups 1 and 2 received the conventional surgical technique, while group 3 underwent surgery with an ultrasonic scalpel. A total of 281 patients treated during 2012–2016 were included: 98 in group 1, 91 in group 2, and 92 in group 3. The mean surgical time and blood loss during surgery, as well as drainage time and amount, were significantly lower for US-MECD (P<0.01). The great auricular nerve and parotid fascia were both preserved with US-MECD (P<0.01), while the rate of capsule rupture with US-MECD was slightly higher than in the other groups (P>0.05). There was less transient facial nerve paralysis and Frey syndrome with US-MECD (P<0.01). No significant difference in wound infection, sialocele, or permanent facial nerve paralysis was observed among the three groups. Patients enrolled during 2012–2013 were selected to evaluate the recurrence rates, and no statistically significant differences were found among the groups. In conclusion, US-MECD showed similar effectiveness and fewer side effects than SP and PSP. The long-term effects of the new technique require further study.

A comparative study to evaluate the outcome between electrocautery versus scalpel skin incision in tension free inguinal hernioplasty: a tertiary care teaching centre experience

Background: The use of cutting electrocautery instead of scalpel for skin incision is still suboptimal worldwide. There are many studies which include its use in general surgical operations but without use of prothetic material mostly, so our study aimed at its use in operations which include use of prosthetic material during abdominal wound closure means in tension free inguinal hernioplasty, exclusively. The objective of this study was to evaluate whether the application of extreme heat by cutting electrocautery may result in significant postoperative pain and poor wound healing with increased risk of wound infection in presence of underlying prosthetic material and poor cosmesis because of excessive tissue damage and scarring respectively as per previous hypothesis or it’s safe and effective instead. Methods: This is a retrospective clinical study conducted in the Department of Surgery, of a teaching tertiary care hospital in Sola, Ahmedabad between May 2013 to April 2014. Patients were allocated consecutively to have either scalpel or cutting electrocautery incisions. The duration used in making the skin incision; the incisional blood loss and the ensuing length and depth of the wound were noted. Postoperative pain; duration of wound healing and the occurrence of surgical site infection and cosmetic outcome were also noted. Results: A total of 196 consecutive patients included to inguinal hernioplasty using the tension-free technique and fulfilling the inclusion criteria for the study were allocated alternately to either electrocautery (n=98) or scalpel (n=98) groups. The ages ranged from 16 to 73 years. The demography, case distribution and body mass index were similar in both groups. The incision time was shorter in the electrocautery group (P <0.001). The blood loss was less with the electrocautery compared to the scalpel (6.53±3.84 ml vs. 18.16±7.36 ml, P<0.001). The cumulative numerical rating scale score for pain was 12.65 (standard deviation SD 8.06) and 17.12 (SD 9.49) in the diathermy and scalpel groups respectively (P<0.001). There was no statistically significant difference in wound infection and wound closure (epithelialization time) (P=0.206). Conclusions: The use of cutting electrocautery in making skin incision during inguinal hernioplasty is as safe as scalpel in terms of wound healing and cosmesis and is also associated with reduced incision time, incisional blood loss, and postoperative pain.

Safety and Effectiveness of a “Percutaneous-First” Approach to Endovascular Aortic Aneurysm Repair

Percutaneous endovascular aneurysm repair (PEVAR) has been increasingly used in the endovascular treatment of abdominal aortic aneurysms. The purpose of this study was to assess the safety and effectiveness of a “percutaneous-first” approach to femoral access for EVAR. From 2012 to 2014, PEVAR was the preferred approach to femoral access for EVAR at our institution. Retrospective review of institutional vascular quality initiative data was used to compare outcomes with PEVAR to a contemporary institutional series of EVAR via open femoral exposure. Matched cohort comparison was used to assess perioperative outcomes, procedural details, including anesthesia modality, surgical time, length of stay (LOS), and access-related complications between groups. A total of 105 consecutive patients underwent attempted PEVAR and were compared with 98 patients undergoing surgical femoral exposure. Demographics and comorbidities were similar between cohorts. PEVAR was associated with an increased use of local anesthesia (67.6% vs 12.2%; P < .001). PEVAR was associated with shorter postoperative LOS (mean, 1.59 vs 3.08 days; P = .044), shorter procedure times (139 vs 222 minutes; P < .001), and significantly less blood loss (176 vs 481 mL; P < .001). There were 11 access site complications (10%) in the PEVAR group, with five (4.8%) requiring conversion to open femoral exposure, compared with three patients (3.1%) with access-related complications after open femoral exposure (P < .001). There were no significant differences in wound infection, intensive care unit LOS, or access site morphology on postoperative computed tomography scan. A PEVAR-first approach proved feasible in the overwhelming majority of patients. Conversion to open transfemoral exposure was rare. PEVAR facilitated endovascular abdominal aortic aneurysm repair under local anesthesia in the majority of patients and resulted in decreased procedural morbidity and resource utilization.

Diathermy versus Scalpel Incision in a Heterogeneous Cohort of General Surgery Patients in a Nigerian Teaching Hospital.

Background:The anecdotal fear of using cautery for surgical incisions is still common in surgical practice despite recent evidences. The aim of this study is to compare the results of electrocautery and the scalpel in skin incisions.Materials and Methods:This is a prospective randomized double blind study conducted in the Department of Surgery, of a teaching hospital in Ibadan. Patients were randomized to have either scalpel or electrocautery incisions. The duration used in making the skin incision; the incisional blood loss and the ensuing length and depth of the wound were noted. Postoperative pain; duration of wound healing and the occurrence of surgical site infection were also noted.Results:There were 197 patients consisting of the scalpel group (n = 98) and the electrocautery group (n = 99). The ages ranged from 16 to 73 years. The demography, case distribution and body mass index were similar in both groups. The mode of presentation was predominantly elective. The incision time was shorter in the electrocautery group (P < 0.001). The blood loss was less with the diathermy compared to the scalpel (6.53 ± 3.84 ml vs. 18.16 ± 7.36 ml, P < 0.001). The cumulative numerical rating scale score for pain was 12.65 (standard deviation [SD] 8.06) and 17.12 (SD 9.49) in the diathermy and scalpel groups respectively (P < 0.001). There was no statistically significant difference in wound infection and wound closure (epithelialization time) (P = 0.206).Conclusion:The use of electrocautery in making skin incision is associated with reduced incision time, incisional blood loss, and postoperative pain.

Skin preparation for preventing infection following caesarean section.

The risk of maternal mortality and morbidity (particularly postoperative infection) is higher for caesarean section than for vaginal birth. With the increasing rate of caesarean section, it is important that the risks to the mother are minimised as far as possible. This review focuses on different forms and methods for preoperative skin preparation to prevent infection. To compare the effects of different agent forms and methods of preoperative skin preparation for preventing postcaesarean infection. We searched the Cochrane Pregnancy and Childbirth Group's Trials Register (26 June 2014) and the reference lists of all included studies and review articles. Randomised and quasi-randomised trials, including cluster-randomised trials, evaluating any type of preoperative skin preparation agents, forms and methods of application for caesarean section. Three review authors independently assessed all potential studies for inclusion, assessed risk of bias and extracted the data using a predesigned form. Data were checked for accuracy. We included six trials with a total of 1522 women. No difference was found in the primary outcomes of either wound infection or endometritis. Two trials of 1294 women, compared drape with no drape (one trial using iodine and the other using chlorhexidine) and found no significant difference in wound infection (risk ratio (RR) 1.29; 95% confidence interval (CI) 0.97 to 1.71). One trial of 79 women comparing alcohol scrub and iodophor drape with iodophor scrub without drape reported no wound infection in either group. One trial of 50 women comparing parachlorometaxylenol plus iodine with iodine alone reported no significant difference in wound infection (RR 0.33; 95% CI 0.04 to 2.99).Two trials reported endometritis, one trial comparing alcohol scrub and iodophor drape with iodophor scrub only found no significant difference (RR 1.62; 95% CI 0.29 to 9.16). The other trial of 50 women comparing parachlorometaxylenol plus iodine with iodine alone reported no significant difference in endometritis (RR 0.88; 95% CI 0.56 to 1.38). One trial of 60 women comparing chlorhexidine gluconate with povidone-iodine reported significant lower rates of bacterial growth at 18 hours after caesarean section (RR 0.23, 95% CI 0.07 to 0.70). No difference was found in the secondary outcome of either length of stay or reduction of skin bacteria colony count. No trial reported other maternal outcomes, i.e. maternal mortality, repeat surgery and re-admission resulting from infection. One trial, which was only available as an abstract, investigated the effect of skin preparation on neonatal adverse events and found cord blood iodine concentration to be significantly higher in the iodine group.Most of the risk of bias in the included studies was unclear in selection bias and attrition bias. The quality of the evidence using GRADE was low for wound infection comparing drape versus no drape, one-minute alcohol scrub with iodophor drape versus five-minute iodophor scrub without drape, and parachlorometaxylenol with iodine versus iodine alone. The quality of the evidence for wound infection comparing chlorhexidine gluconate with povidone-iodine was very low. This review found that chlorhexidine gluconate compared with iodine alone was associated with lower rates of bacterial growth at 18 hours after caesarean section. However, this outcome was judged as very low quality of evidence. Little evidence is available from the included randomised controlled trials to evaluate different agent forms, concentrations and methods of skin preparation for preventing infection following caesarean section. Therefore, it is not yet clear what sort of skin preparation may be most efficient for preventing postcaesarean wound and surgical site infection.There is a need for high-quality, properly designed randomised controlled trials with larger sample sizes in this field. High priority questions include comparing types of antiseptic (especially iodine versus chlorhexidine), the timing and duration of applying the antiseptic (especially previous night versus day of surgery, and application methods (scrubbing, swabbing and draping).

Caesarean section versus vaginal delivery for preterm birth in singletons

Planned caesarean delivery for women thought be in preterm labour may be protective for baby, but could also be quite traumatic for both mother and baby. The optimal mode of delivery of preterm babies for both cephalic and breech presentation remains, therefore, controversial. To assess the effects of a policy of planned immediate caesarean delivery versus planned vaginal birth for women in preterm labour. We searched the Cochrane Pregnancy and Childbirth Group's Trials Register (5 August 2013). Randomised trials comparing a policy of planned immediate caesarean delivery versus planned vaginal delivery for preterm birth. Two review authors independently assessed trials for inclusion. Two review authors independently extracted data and assessed risk of bias. Data were checked for accuracy. We included six studies (involving 122 women) but only four studies (involving only 116 women) contributed data to the analyses. INFANT: There were very little data of relevance to the three main (primary) outcomes considered in this review: There was no significant difference between planned immediate caesarean section and planned vaginal delivery with respect to birth injury to infant (risk ratio (RR) 0.56, 95%, confidence interval (CI) 0.05 to 5.62; one trial, 38 women) or birth asphyxia (RR 1.63, 95% CI 0.84 to 3.14; one trial, 12 women). The only cases of birth trauma were a laceration of the buttock in a baby who was delivered by caesarean section and mild bruising in another allocated to the group delivered vaginally.The difference between the two groups with regard to perinatal deaths was not significant (0.29, 95% CI 0.07 to 1.14; three trials, 89 women) and there were no data specifically relating to neonatal admission to special care and/or intensive care unit.There was also no difference between the caesarean or vaginal delivery groups in terms of markers of possible birth asphyxia (RR 1.63, 95% CI 0.84 to 3.14; one trial, 12 women) or Apgar score less than seven at five minutes (RR 0.83, 95% CI 0.43 to 1.60; four trials, 115 women) and no difference in attempts at breastfeeding (RR 1.40, 95% 0.11 to 17.45; one trial, 12 women). There was also no difference in neonatal fitting/seizures (RR 0.22, 95% CI 0.01 to 4.32; three trials, 77 women), hypoxic ischaemic encephalopathy (RR 4.00, 95% CI 0.20 to 82.01;one trial, 12 women) or respiratory distress syndrome (RR 0.55, 95% CI 0.27 to 1.10; three trials, 103 women). There were no data reported in the trials specifically relating to meconium aspiration. There was also no significant difference between the two groups for abnormal follow-up in childhood (RR 0.65, 95% CI 0.19 to 2.22; one trial, 38 women) or delivery less than seven days after entry (RR 0.95, 95% CI 0.73 to 1.24; two trials, 51 women). MOTHER: There were no data reported on maternal admissions to intensive care. However, there were seven cases of major maternal postpartum complications in the group allocated to planned immediate caesarean section and none in the group randomised to vaginal delivery (RR 7.21, 95% CI 1.37 to 38.08; four trials, 116 women).There were no data reported in the trials specifically relating to maternal satisfaction (postnatal). There was no significant difference between the two groups with regard to postpartum haemorrhage. A number of non-prespecified secondary outcomes were also considered in the analyses. There was a significant advantage for women in the vaginal delivery group with respect to maternal puerperal pyrexia (RR 2.98, 95% CI 1.18 to 7.53; three trials, 89 women) and other maternal infection (RR 2.63, 95% CI 1.02 to 6.78; three trials, 103 women), but no significant differences in wound infection (RR 1.16, 95% CI 0.18 to 7.70; three trials, 103 women), maternal stay more than 10 days (RR 1.27, 95% CI 0.35 to 4.65; three trials, 78 women) or the need for blood transfusion (results not estimable). There is not enough evidence to evaluate the use of a policy of planned immediate caesarean delivery for preterm babies. Further studies are needed in this area, but recruitment is proving difficult.

Primary linear closure with closed suction wound drain after ileostomy takedown

Purpose: Wound infection after ileostomy takedown is one of the significant complications. Conventional linear closure has been reported to be associated with a significantly higher incidence of wound infection. We aimed to evaluate the surgical outcomes of primary linear closure with closed suction wound drain following a loop ileostomy takedown. Methods: Between October 2007 and October 2012, a total of 121 patients who underwent primary linear closure with closed suction wound drain after ileostomy takedown were included, and their surgical outcomes were compared with those of 34 patients who underwent delayed wound closure between July 2002 and September 2007 as a historical control group . Results: Between primary linear closure with closed suction wound drain group and delayed wound closure group, there were no differences of gender, age, body mass index, American Society of Anesthesiologists (ASA) scores and comorbidities such as pulmonary disease and hypertension and diabetes . The chemotherapy rate is similar in the two groups (group I, 52.9%; group II, 44.6%; P=0.39). There was a significant difference in wound infection (group I, 23.5%; group II, 5.6%; P=0.002). There was no significant difference in the length of postoperative hospital stay (P=0.26). Small bowel obstruction was not significantly different between the two groups (group I, 11.8%; group II, 7.4%; P=0.42). Conclusion: Primary linear wound closure with closed suction wound after a loop ileostomy takedown showed comparable outcomes, in terms of wound infection rates to those of delayed wound closure. Thus, primary linear wound closure with closed suction drain after a loop ileostomy takedown could be a good alternative to the delayed closure or purse-string closure. Keywords: Ilestomy closure, Ileostomy takedown, Wound infection, Closed suction drain

Prophylactic retention sutures in midline laparotomy in high-risk patients for wound dehiscence: A randomized controlled trial

BackgroundAbdominal wound dehiscence (WD) is a postoperative complication with high mortality and morbidity rates. Retention sutures are often used in surgical take-back for dehiscence. The aim of this study was to assess the reduced rate of dehiscence in midline laparotomy using prophylactic retention sutures in high-risk patients. Materials and methodsThree hundred high-risk patients with at least two risk factors for dehiscence who underwent midline laparotomy between 2008 and 2010 were randomly divided into two groups. In the control group, the fascia was continuously repaired using a running looped #1 nylon suture. For the intervention group, we added retention sutures that included the skin, subcutaneous tissue, rectus muscle, and abdominal fascia. We compared the rates of WD, evisceration, wound infection, postoperative pain, postdehiscence mortality, and late incisional hernia for these two groups. ResultsAfter accounting for early mortalities, 147 patients were followed in the intervention group and 148 patients in the control group. WD occurred in 6 patients (4%) in the intervention group and 20 control patients (13.3%) (P = 0.007). Abdominal evisceration after surgery occurred in 1 patient (0.7%) with retention sutures and 4 control patients (2.7%) (P = 0.371). There was no significant difference in wound infection and incisional hernia between the two groups. Postoperative pain scores between the two groups did not differ significantly during the first 3 d, but did differ on the fourth day. ConclusionProphylactic retention sutures reduce the occurrence of WD following midline laparotomy in high-risk patients with multiple risk factors for impaired wound healing without imposing remarkable postoperative complications.

Mechanical dilatation of the cervix at non-labour caesarean section for reducing postoperative morbidity

During non-labour caesarean, some obstetricians routinely dilate the cervix from above--using finger, sponge forceps or other instruments because they believe that the cervix of women without labour pain is undilated and may cause obstruction of blood or lochia drainage. However, mechanical cervical dilatation using sponge forceps or a finger during caesarean section may result in contamination by vaginal micro-organisms during dilatation, and increase the risk of infection or cervical trauma. To determine the effects of mechanical dilatation of the cervix during elective/non-labour caesarean section on postoperative morbidity. We searched the Cochrane Pregnancy and Childbirth Group's Trials Register (31 August 2011). All randomised or quasi-randomised controlled trials comparing intraoperative cervical dilatation using a finger, sponge forceps or other instrument during non-labour caesarean section versus no mechanical dilatation. Two review authors independently assessed studies for inclusion, assessed the risk of bias of each included study and extracted data. We included three trials with a total of 735 women undergoing elective caesarean section. Of these women, 338 underwent intraoperative cervical dilatation with a double-gloved index digit inserted into the cervical canal to dilate, and 397 did not undergo intraoperative cervical dilatation. Three included trials had moderate-to-high risk of bias. None of the three trials reported our primary outcome of postpartum haemorrhage. In one study of 400 women, blood loss was significantly lower in the cervical dilatation group compared with the no dilatation group (mean difference (MD) -48.49 ml, 95% confidence interval (CI) -88.75 to -8.23). The incidence of febrile morbidity and haemoglobin concentrations in the postoperative period in women undergoing intraoperative cervical dilatation was not significantly different from those who did not receive cervical dilatation (risk ratio (RR) 1.07, 95% CI 0.52 to 2.21 (three trials, 735 women) and MD -0.05 g/dl, 95% CI -0.17 to 0.06 (two trials, 552 women), respectively. There were no significant differences in wound infection, change of haemoglobin level, hematocrit level at postoperative period, endometritis, infectious morbidity, or urinary tract infection. There was a significant difference in operative time, which was reduced in cervical dilatation group (MD -1.84 mins, 95% CI -2.21 to -1.47 (one study, 400 women), but this is of doubtful clinical significance. There was insufficient evidence of mechanical dilatation of the cervix at non-labour caesarean section for reducing postoperative morbidity. Further randomised controlled trials with adequate methodological quality comparing intraoperative cervical dilatation using a finger, sponge forceps or other instrument during non-labour caesarean section versus no mechanical dilatation for reducing postoperative morbidity are needed.

Computed Tomography-guided Percutaneous Drainage in the Management of Intraperitoneal Abscess

We carried out a retrospective analysis of 84 patients with intraperitoneal abscesses treated at Kaohsiung Medical University Hospital, Taiwan to assess our experience in their management. We compared outcomes between surgical drainage and computed tomography (CT)-guided percutaneous drainage. Each patient's characteristics, origin of abscess, clinical presentation, microbiology, Acute Physiology and Chronic Health Evaluation (APACHE) II score, treatment, and clinical outcomes were recorded. We compared patients' age, sex, complications, hospitalization days, morbidity, and mortality rate between those receiving surgical treatment and those receiving CT-guided percutaneous drainage. The most frequent symptoms and signs of these patients were leukocytosis, followed by fever and abdominal pain. There were significant differences in wound infection ( p = 0.007), recurrent rate ( p = 0.009), and enterocutaneous fistula ( p = 0.032) between the two groups. In both groups, a higher APACHE II score was associated with both a higher morbidity and mortality ( p < 0.001). Despite the higher recurrent rate, CT-guided percutaneous drainage was a safe and effective therapeutic alternative procedure to surgery when used as a definitive treatment. Surgical treatment is suggested in selected patients with either a complicated intraperitoneal abscess or failed CT-guided drainage.

Outcome of colostomy closure with different skin closure techniques in a developing country

Colostomy site, which is a potentially contaminated wound, is traditionally closed with interrupted skin stitches and placement of intraperitoneal or parietal or both drains; often with poor cosmetic outcome in our country. This study aims at prospective evaluation of colostomy closure wounds by different techniques. This study was carried out in all infants and children with colostomy (for different pathologies) admitted for colostomy closure in our institute from August 1, 2006 to February 29, 2008. Patients were divided into two groups: Group A with colostomy closure without any drain and subcuticular skin closure and Group B with colostomy closure with both intraperitoneal and parietal drain and interrupted skin closure. Patient's details, including age, sex, body weight, diagnosis, preoperative bowel preparation, peroperative antibiotics, postoperative wound infection, anastomotic leaks, duration of hospitalisation and postoperative follow-up for wound assessment, were recorded. By the end of February 2008, 151 cases of colostomy closure were recorded, 70 in Group A and 81 in Group B. Statistical analysis of the data showed no statistically significant difference in wound infection and anastomotic leak between the two groups. On postoperative follow-up, wound assessment showed significantly better cosmesis in the no drain subcuticular group. This study shows that closing colostomies without any drain and subcuticular skin closure does not result in any increased incidence of wound infection and has better cosmetic results.

Intraarticular distal radial fractures

Results of four randomized controlled trials, Class of evidence (CoE) II, comparing external fixation (EF) with open reduction and internal fixation (ORIF) for the treatment of intra-articular distal radius fractures described no consistent benefit of one treatment over another. Grip strength was better among those treated with EF compared with ORIF in two studies, but statistical significance was not consistent. No statistically significant differences in wound infection or reflex sympathetic dystrophy were seen between treatment groups. Larger, methodologically sound randomized controlled trials are needed to evaluate the superiority of one treatment over the other for intra-articular distal radius fractures.

Finger-assisted stretching technique for cesarean section

Objective To compare the perioperative outcomes of two cesarean section methods, the finger-assisted stretching technique (FAST), based on a modified Joel-Cohen method, with the traditional technique. Methods A retrospective review of the records of 416 women who underwent cesarean sections at Guro Hospital, Seoul, Korea, between May 1993 and December 2001 was performed. Of the 416 women, 283 underwent cesarean sections with FAST and 133 with the traditional technique. Results Operative time was significantly shorter with FAST (15.3 vs. 42.6 min, P < .05), and FAST was associated with lower blood loss (601 vs. 928 mL, P < .05) and shorter hospital stay (3.7 vs. 6.5 days, P < .05). There were no significant differences in wound infection, voiding difficulty, and postoperative adhesions between the two methods. Conclusion These results suggest that FAST may be the better technique.

Interventions for replacing missing teeth: bone augmentation techniques for dental implant treatment.

Dental implants require sufficient bone to adequately stabilise. For some patients implant treatment would not be an option without bone augmentation. A variety of materials and surgical techniques are available for use in bone augmentation. To test the null hypothesis of no difference in the success, function, morbidity and patient satisfaction between different bone augmentation techniques for dental implant treatment. The Cochrane Oral Health Group's Trials Register, the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE and EMBASE were searched. Several dental journals were handsearched. The bibliographies of review articles were checked, and personal references were searched. Implant manufacturing companies were also contacted. Randomised controlled trials (RCTs) of different techniques and materials for augmenting bone for implant treatment. Quality assessment was carried out and authors were contacted for any missing information. Data were independently extracted in duplicate. Four RCTs (n = 95) were suitable for inclusion in this review, assessing three different aspects of bone augmentation techniques: onlay grafting with and without a barrier membrane, grafting with a resorbable and non-resorbable membrane, and membranes for guided bone regeneration (GBR). Trials reported on augmentation procedures up to abutment connection only. At the patient level there were no statistically significant differences for the alternative techniques for onlay grafting with respect to the degree of bone graft resorption and wound dehiscence. One trial showed statistically significantly more infections in the non-resorbable group compared to the resorbable group, relative risk 0.05 (95% confidence interval (CI): 0.00 to 0.74). One study of GBR with a resorbable versus non-resorbable membrane indicated no statistically significant difference in early implant failure, reduction in bone defect or wound dehiscence. The other GBR study compared a non-resorbable membrane with no membrane and reported no statistically significant difference in wound infection or dehiscence but a significant increase in per cent bone gain for the test group compared to control, mean difference = 70 (95% CI: 36 to 104, p = 0.002). There is no evidence from available RCTs supporting superior success with one or other of the alternative techniques examined. There was weak evidence that a non-resorbable membrane was better than no membrane for permitting bone growth about dental implants, and that a resorbable membrane over a bone graft may allow healing with fewer infections than a non-resorbable membrane.

Abdominal incisions: techniques and postoperative complications.

The choice of incision for laparotomy depends on the area that needs to be exposed, the elective or emergency nature of the operation and personal preference. Type of incision may however have its influence on the occurrence of postoperative wound complications. Techniques and features of various incisions are discussed, as well as the incidence of their postoperative complications. A medline search was conducted identifying prospective randomised trials, as well as retrospective studies with sufficient follow-up, comparing midline, paramedian, transverse and oblique incisions. Significant differences in wound infection and wound dehiscence rates were not reported. Transverse, oblique and paramedian incisions caused significantly less incisional hernias than midline incisions. However, trials comparing transverse and midline incisions for larger laparotomies did not show significant differences. All four trials comparing lateral paramedian with midline incisions reported incisional hernia rates of 0% after the lateral paramedian incision. Differences with the midline incision were significant. Transverse or oblique incisions should be preferred for small unilateral operations. The paramedian incision should be used for major elective laparotomies. The use of the midline incision should be restricted to operations in which unlimited access to the abdominal cavity is useful or necessary.